Healthcare Provider Details

I. General information

NPI: 1457467581
Provider Name (Legal Business Name): CHARLA K GUYON RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 S LANCASTER RD
DALLAS TX
75216-7167
US

IV. Provider business mailing address

206 BROOKWOOD DR
DUNCANVILLE TX
75116-4503
US

V. Phone/Fax

Practice location:
  • Phone: 214-759-2882
  • Fax:
Mailing address:
  • Phone: 972-298-4240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberDT00996
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: